Modulation of human cervical premotoneurons during bilateral voluntary contraction of upper-limb muscles.

A greater proportion of the voluntary command to the affected upper limb of well-recovered stroke patients descends via the putative C3/4 propriospinal system compared with the unaffected limb or the limbs of control subjects. We have examined whether there are differences in the pattern and extent of the modulation in intact subjects when the upper-limb muscles are bilaterally activated compared with unilateral activation. Motor evoked potentials (MEPs) recorded from flexor carpi radialis (FCR) in response to transcranial magnetic stimulation (TMS) were assessed for an effect of cocontraction with biceps brachii (BB) and subthreshold electrical conditioning of the musculocutaneous (MC) nerve. No between-hand differences were revealed, but there was less facilitation during bilateral than unilateral contraction. The findings suggest that the C3/4 propriospinal system is more active during unilateral muscle contraction and less active during bilateral contraction of upper-limb muscles. Therefore, bimanual rehabilitation strategies for patients with upper-limb hemiparesis should be developed with caution.